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Choledocholithiasis
Aka: Choledocholithiasis, Common Bile Duct Stone, Common Duct Stone
- See Also
- Gallstone (Cholelithiasis)
- Biliary Colic
- Acute Cholecystitis
- Acute Gallstone Cholangitis (Ascending Cholangitis)
- Acalculous Cholecystitis
- Definition
- Gallstone in the Common Bile Duct
- Epidemiology
- Occurs in 6-12% of patients with Gallstones
- Common Bile Duct Stones pass spontaneously in 73% of cases
- Signs
- Biliary Colic
- Acute Cholecystitis
- Ascending Cholangitis
- Gallstone Pancreatitis (with Gallstone lodged at the sphincter of oddi)
- Labs
- Liver Function Tests (hepatic panel)
- Increased transaminases
- Increased cholestasis labs
- Total Serum Bilirubin >4 mg/dl
- Pancreatic labs
- Increased Lipase if gallstone Pancreatitis present
- Imaging
- Ultrasound
- Common bile duct dilitation >6 mm (some guidelines use 8 mm cut-off)
- Magnetic Resonance Cholangiopancreatography (MRCP)
- Indicated where the Ultrasound and lab findings are non-diagnostic for a still suspected Common Duct Stone
- Complications
- Recurrent biliary symptoms despite Cholecystectomy
- Ascending Cholangitis
- Gallstone Pancreatitis
- Management
- Laparoscopic Cholecystectomy and
- Common Bile Duct Stone removal
- Laparoscopic stone extraction (preferred) or
- Intraoperative cholangiography or
- Selective postoperative ERCP if stones present
- Preoperative ERCP and then Cholecystectomy
- References
- Abraham (2014) Am Fam Physician 89(10): 795-802 [PubMed]
- Portincasa (2006) Lancet 368(9531):230-9 [PubMed]
- Urbach (2001) Surg Endosc 15:4-13 [PubMed]